Painful sex is one of the most common issues we see, and one of the least talked about. Many women put up with it for years before mentioning it to anyone, often because they feel embarrassed or because they have been told it is “just in your head”. It is not. Painful sex almost always has a real physical cause, and in most cases there is something that can be done to help. This guide walks you through the common causes and the full treatment pathway.

What is dyspareunia?

Dyspareunia is the medical term for pain during or after sex. It can be felt at the entrance of the vagina (superficial dyspareunia) or deep inside the pelvis (deep dyspareunia). Some women have both. The pain might feel sharp, burning, stinging, deep, or like a cramp. It might happen every time or only sometimes.

How common is painful sex?

Around 1 in 5 women will experience painful sex at some point in their life. Among women around menopause, that number climbs much higher. Despite being common, painful sex is one of the most under-reported gynaecology issues, which means many women go years without a diagnosis.

Common causes of painful sex

Vaginal dryness

This is the single most common cause, especially after menopause. Low oestrogen makes the vaginal walls thinner, drier, and less flexible. Our blog on effective treatment for vaginal dryness covers the full range of options from moisturisers to vaginal oestrogen.

Vaginal muscle tightness (vaginismus)

The muscles of the pelvic floor tense up involuntarily, making penetration painful or impossible. It is not under conscious control. It can happen in women who have never had pain-free sex (primary vaginismus) or in women who develop it after an injury, infection, or difficult experience.

Endometriosis

Pain deep inside with sex is a classic sign of endometriosis. Certain positions make it worse. The pain is often also present during periods or ovulation.

Pelvic floor dysfunction

The muscles of the pelvic floor can become too tight, too weak, or poorly coordinated. This is especially common after childbirth, menopause, or alongside pelvic prolapse. Pelvic floor physiotherapy is a key part of treatment.

Vulval skin conditions

Conditions like lichen sclerosus, lichen planus, and chronic eczema can make the vulval skin fragile and sore. Our blog on vulval disorders covers these in detail.

Vulvodynia

Vulvodynia is chronic pain or burning of the vulva that has no obvious cause. It is a real nerve-related condition and there are specific treatments that can help, including topical medications, nerve-settling medications, and pelvic floor work.

Infections

Thrush, bacterial vaginosis, and sexually transmitted infections can cause pain. These are usually easy to diagnose and treat.

Scar tissue after childbirth or surgery

Scar tissue from an episiotomy, tear, or previous gynaecology surgery can be sensitive or tight.

Psychological factors

Anxiety, past trauma, relationship stress, or the fear of pain (after it has already happened) can all contribute. These do not mean the pain is “in your head”. They mean the mind-body loop is one of the pieces of the puzzle, and it is worth addressing alongside the physical causes.

How is painful sex diagnosed?

A good assessment is unhurried and respectful. At your appointment, your specialist will:

1. Ask about when the pain started, where it is felt, what makes it better or worse, your periods, your menopause status, your relationships, and any history of infection or surgery.

2. Carry out a gentle external examination of the vulva and vagina, with your consent and at your pace. If any part of the examination is too uncomfortable, we stop.

3. Take swabs if an infection is suspected.

4. Arrange a pelvic ultrasound if deep pain suggests endometriosis, fibroids, or ovarian cysts.

5. In some cases, arrange hormonal blood tests or further scans.

You do not have to have an examination at your first visit if you are not ready. A conversation first is always an option.

Treatment options for painful sex

Treatment depends on the cause. For most women the plan has more than one element.

For dryness and atrophy

Non-hormonal moisturisers for daily use, lubricants during sex, and low-dose vaginal oestrogen are first-line. For women who cannot use hormones, vaginal PRP using growth factors from your own blood is an option our team offers.

For muscle tightness and pelvic floor issues

Pelvic floor physiotherapy with a specialist pelvic physio is the single most helpful step for many women. Techniques include manual therapy, dilator training, breathing work, and relaxation.

For endometriosis-related pain

Hormonal treatment, pelvic floor work, pain modulation, and sometimes laparoscopic surgery depending on severity.

For vulvodynia and skin conditions

Diagnosis after a vulvoscopy with specific topical treatments, nerve-modulating medications, and gentle vulval care routines. 

For emotional and relationship impact

Short-term counselling, especially with a therapist who specialises in sexual health, can be very helpful. Our blog on sex after menopause also covers the broader intimacy picture.

When to see a specialist

See a specialist gynaecologist when:

1. The pain has been going on for more than 3 months.

2. The first thing your GP tried has not helped.

3. You have pain during periods or at other times too, suggesting endometriosis.

4. There are visible changes on the vulva (whitening, cracking, redness).

5. The pain is affecting your relationship, your confidence, or your mental health.

About Northside Gynaecology and painful sex care

Northside Gynaecology is a specialist gynaecology practice in Brisbane. Our team, led by Dr Archna Saraswat, FRANZCOG, has supported women with painful sex since 2011. We work closely with specialist pelvic floor physiotherapists, pain specialists, and counsellors so that your plan can address every piece of the puzzle. We consult from Kedron, North Lakes, and Caboolture Private Hospital.

Frequently asked questions

Is painful sex common?

Yes, very common. Around 1 in 5 women experience painful sex at some point in their lives. It can happen at any age and for many different reasons. Despite being common, many women never talk about it, which is why so many go years without a proper diagnosis and treatment.

What are the most common causes of painful sex?

The most common causes include vaginal dryness (especially after menopause), vaginal muscle tightness (vaginismus), endometriosis, pelvic floor dysfunction, vulval skin conditions, infections, and sometimes psychological factors. Often more than one cause is involved.

Can painful sex be cured?

Most causes of painful sex can be significantly improved or completely treated once the right diagnosis is made. The key is a proper assessment that looks at all possible causes together, not just one. Many women see a big improvement within a few months of starting the right plan.

Should I see a GP or a specialist for painful sex?

A GP is a good first step for straightforward causes. See a specialist gynaecologist if the pain has been going on for months, if the first thing your GP tried has not helped, or if the examination suggests a condition like endometriosis or a skin disorder.

Can painful sex affect my relationship?

Yes, often it does. Avoiding sex, feeling anxious before intimacy, and loss of closeness are all common. The good news is that getting the right medical treatment usually also helps the emotional side. Many couples benefit from honest conversation and sometimes short-term counselling alongside the medical plan.

Will I have to have a full examination at the first visit?

No. If you are not ready for an examination, we can start with just a conversation. The examination can wait until you feel comfortable, and we always go at your pace, stopping if anything is too uncomfortable.

Can painful sex come back after treatment?

For some women yes, especially if the underlying cause (such as menopause or endometriosis) is ongoing. The plan is usually about long-term management rather than a single fix. Regular reviews help keep things on track.

Book a painful sex consultation in Brisbane

Painful sex is not something you have to accept or put up with. The right diagnosis changes everything. Please do not spend any more years silent about this.

You can book at Kedron, North Lakes, or Caboolture. Call 07 3054 4687 or use our contact page. Ask your GP for a referral so you can claim your Medicare rebate. We will take the time needed, listen without judgement, and build a plan at your pace.